TB/HIV Advocates Demand Political Commitment

Treatment advocates from across the globe have challenged national governments and multi-lateral agencies to demonstrate greater political will and commitment in their response to the dual epidemics of tuberculosis (TB) and HIV.

The advocates warned that the apathy demonstrated in the addressing the TB epidemic could grossly undermine efforts to address HIV, as both are inextricably linked.

They also identified poor funding of TB programs, slow pace of operational research into newer drugs and diagnostics for TB management and poor standard of care for clients with TB and HIV as key issues which national governments must prioritize, if the global TB/HIV burden is to be reduced.

Over 40 advocates from 32 countries issued the call on October 29, 2004 at the end of the 3rd International TB/HIV Community Mobilization Workshop, held in Paris, France.

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Designed to update participant's knowledge on recent developments in TB and HIV research, the workshop provided an avenue for sharing of country experiences, defining the advocacy agenda and planning of appropriate advocacy strategies to strengthen AIDS and TB control programs in their respective countries.

The workshop also provided a platform for treatment advocates to participate in the Working Group meetings of the STOP-TB Partnership of the World Health Organization (WHO), 35th International Union Against Tuberculosis and Lung Disease (IUATLD) World Conference, held from October 28 to November 1, where they voiced several concerns about the inadequate involvement of people living with HIV/TB (PLWH/TB) in policy making decisions affecting their lives.

Two Diseases in One Patient

"TB is the main killer of people living with HIV (PLWH). The diagnosis of TB has not changed in the last 100 years and management of the disease is not patient centered," said Lillian Mworeko of the National Forum of PLWH Networks in Uganda.

Dr. Lydia Mungherera of The AIDS Support Organization (TASO) Uganda, observed that although political commitment is a key element of the World Health Organization's strategy for controlling TB, this is still often times non-existent in many countries.

"Many TB patients still can not receive the quality treatment and care they need. If 70 percent of PLWH who are worst hit with TB cannot get treatment, then how do governments expect to provide antiretroviral drugs," she queried.

But Ezio Santos Filho of Gruppo Pela Vidda, a PLWH based group in Brazil cautioned that making treatment available alone without advocacy for the implementation of TB/HIV collaborative policies would not address the dual TB/HIV epidemics effectively.

He observed that despite Brazil's leading role in the manufacture of generic antiretroviral drugs and the existence of a free TB treatment policy, the lack of political will and a poor policy implementation process continue to make TB a major health problem in Brazil.

Mohammed Farouk Auwalu of the AIDS Alliance, a PLWH support group in Nigeria, also stressed the need for the emergence of a strong civil society movement, which would hold national governments accountable to commitments made.

"In April 2001, African Leaders at the Abuja Summit committed to spending 15 percent of their annual budget on health and particularly to addressing TB, HIV and Malaria. Our leaders need to show us their score card of how they have fared with respect to this commitment," he said.

Participants noted that the huge amounts of money spent by developing countries on debt service, coupled with the strict macro-economic policies of the World Bank and the International Monetary Fund (IMF) places a major limitation on the health sector's inability in these countries to secure qualified manpower and personnel to adequately respond to TB, which is a disease of the poor.

Several regional and global advocacy strategies were proposed by participants at the end of the various break-out meetings held during the four-day workshop.

These advocacy strategies aim at strengthening TB/HIV collaborative activities within countries, advocating for the adoption and implementation of the WHO interim Collaborative TB/HIV Policy at country levels as well as advancing operational research into newer drugs and diagnostics for TB.

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